PROVO — When life at home becomes too brutal, when the threat is so severe and she worries her children will endure yet another suffocating attack, Christine Frandsen packs some bags.

She and her four children flee to safety, turning wistfully at what they must leave behind: the comfort of her own home, friends, school, the stability of everyday life.

When they arrive at their new destination, they can all breathe easier. Literally.

The ugly monster that chases them away from their familiar cocoon is the abusive air of the Wasatch Front. It is the air that put Lucy, 6, in the hospital in December and left her lashing out in frustration.

"She hates her asthma, she screamed that at me during the last hospital stay a few weeks ago, when it looked like she might be there for Christmas," Christine Frandsen said.

Utah's dirty air is costing people their health, and in some cases, their lives. It's costing the state millions of dollars, muddying Utah's reputation as a pristine, clean place to raise a family, grow a business.

And it is causing very real political headaches for Utah's top elected officials as they try to figure out cost-effective, reasonable ways to scrub the airshed or ponder a list of harsh and perhaps more expensive measures to eliminate the culprits: the PM2.5, or fine particulate matter, and its sidekicks of nitrogen oxides, volatile organic compounds and sulfur dioxide.

The problem

The Wasatch Front has a very real pollution problem. Seven counties, or portions of them, do not meet federal Clean Air standards for PM2.5, tiny microscopic particles that enter our airways and settle in the lungs.

This PM2.5 is found in direct emissions that are part of the air pollution and formed by precursor gasses generated by transportation, industry, homes, agricultural operations, businesses. In other words, by those living and working in Utah.

And when it comes to exposure to air pollution, the research is in; there have been more than two dozen signficant studies in Utah looking at local impacts and the health risks associated with exposure to fine particulates.

"It increases respiratory admissions to hospitals and emergency rooms, cardiac events, reduces lung function and increases risk of death," said Arden Pope, a Brigham Young University economics professor whose seminal research in the 1980s in Utah County forged the link between health impacts and air pollution exposure.

"It is clearly true that we are understanding the health effects more and more. In the mid-1980s pollution was substantially worse than it is now and there were a lot of people who denied it had any effect. Now, almost everybody understands that the dirty air that we still have contributes to adverse health outcomes."

Especially those with health issues. About 8 percent of males up to age 17 in Utah have asthma, while just over 6 percent of female children do. In 2011, the Utah Department of Health counted nearly 2,000 visits to the emergency room due to asthma and air pollution exposure may have been an aggravating factor.

Local research suggests a correlation between prolonged or chronic exposure to air pollution and an uptick in visits to the emergency room by sensitive populations, which includes Utah's growing elderly population, but additional study is needed to determine the extent that inversions play.

Worse than Beijing?

Mayors and other community leaders say they have Utahns tell them that the poor air quality has chased families and businesses away.

Earlier this year, the Economic Development Task Force identified the Wasatch Front's air pollution problem as one of the state's most pressing challenges.

News reports compare the Wasatch Front's dirty air to Detroit, Los Angeles, or even Beijing, China, and those comparisons show The Wasatch Front as being the worst of the worst.

The comparisons are alternately true, yet false.

On Monday, the air pollution index showed the Salt Lake metro area as worse than Beijing. On Wednesday, the air was better.

"We certainly do not have a monopoly on bad air," said Bo Call, manager of the Utah Division of Air Quality's air monitoring section. "On any given day, the weather is cleaning out an inversion in a metropolitan area. At some point during the year, we always have a day where everybody else has gotten cleaned out and we are worse. It is all a matter of perspective."

Bryce Bird, state air quality division director, shepherded the agency's cobbling of a State Implementation Plan to bring the seven counties into "attainment" status with the federal Clean Air Act for PM2.5 by 2019.

"To say we have the worst air in the nation is absolutely false," Bird said, pointing to the 2013 American Lung Association's State of the Air Report that, even for short-term particle pollution, ranks the Salt Lake City metro area as No. 6 in the country for its dirty air, behind five other spots in California.

Call said a barometer of air quality to consider is the year-round levels and what that annual average number for particulate matter is – and Utah does not even land on the list.

"China's numbers are in the 30s and 40s, our number is around eight or nine...Our pollution is episodic. The rest of the time is pretty good for particulates," he said.

Episodic or not, the dirty air of the Wasatch Front has led secondary schools to invoke outdoor exposure guidelines for school children. It has spawned multiple public information campaigns and millions of dollars for fixes.

Ultimately, temperature inversions may blow out with the next storm. But that's little consolation for those fearing the lasting impacts of bad air.

Dealing with the problem

"No one who hasn't experienced it knows what it's like, and it's taught me not to judge" said Christine Frandsen. "I resisted so much at first but then realized that in order to keep Lucy as safe as possible I had to become that mom."

She said the constant vigilance is draining.

"If I am really careful to keep up with all the tiny pieces that help keep her well, it seems to really help. Meanwhile, if she's well enough to go out, what people see is a child who looks pretty healthy, followed closely by a helicopter mom who is trying her best to wipe the intensity off her face."

All four of Brigham and Christine Patterson Frandsen's children have asthma. A year ago, when January's persistent inversions held the Wasatch Front in an unrelenting grip, Christine Frandsen took the children to their grandparents in St. George.

Between two of her children, they had battled pneumonia 10 times. Even Christine, with her healthy lungs, was feeling the chokehold of the inversion.

"I told my husband it felt like my mouth was around an exhaust pipe all day," she said. "I felt like I was constantly breathing exhaust."

Christine Frandsen said she knows eyebrows may go up when she pulls her children from school, but she said the decision is simple for her.

"They either miss school and are healthy or they miss school because they are in the hospital."

Bad air days

During last year's inversion season, the Wasatch Front had 35 days in which air pollution levels climbed to an unhealthy threshold in which residents were asked to take action.

The clean air advocacy group Utah Physicians for a Healthy Environment argues that threshold or no, federal Clean Air standard or not, there is no "safe" amount of air pollution that one can be exposed to. Last year, the World Health Organization deemed air pollution a carcinogen.

In a study published this week in the British Medical Journal, researchers found that living in a city increases the chance of having a heart attack by 13 percent because air pollution is higher.

The study followed 100,000 people for nearly 12 years and noted that an uptick of PM.25 by just 5 micrograms over the long-term is akin to the difference between being an urban dweller and living in a less-polluted rural area.

Researchers concluded that the European limits for particulate matter ought to be lowered, reasoning that additional reduction of PM2.5 levels would result in improvements to cardiac health over the long-term.

Improved health

For Christine Frandsen, in just the four hours it takes to travel from their home in Provo to St. George, she sees a marked improvement in the vitality of her own children, especially Lucy.

"She'll get stronger, then I have to bring her back."

The Wasatch Front's episodic bouts with air pollution leave the family on edge — worrying and wondering when the next unhealthy blow will come, and when Lucy will suffer the consequences.

"When she has a good week or a good month we all breathe easier, I feel the tightness in my chest relax too, but mine is caused by anxiety and worry," the mother said.

"I can't tell you how many days and nights her dad and I have held her and worried over every labored breath, asking ourselves every minute if it's time to take her to the ER, if we need an ambulance, if it's still something we can handle at home — because it's in the hundreds."